Surgical treatment of primary pulmonary sarcomas

Objective: We sought to identify the long-term prognosis after surgical tre atment for primary pulmonary sarcoma. Methods: Twenty-three patients were r etrospectively identified as having been treated surgically for primary pul monary sarcoma between 1981 and 1996. The records of all patients were revi ewed, and the histopathology reexamined by a pathologist. Results: Fifteen patients were male and eight female; their ages ranged from 20 to 78 (mean 51) years. Tumors measured between 0.9 and 12.0 (mean 5.2) cm across the gr eatest diameter. The histologic diagnoses were malignant fibrous histiocyto ma (8, three grade 1 or 2, two grade 3), synovial sarcoma (4), malignant sc hwannoma (3), leiomyosarcoma (3), and one case each of angiosarcoma, intima l sarcoma, epitheloid hemangioendothelioma, fibrosarcoma and primitive neur oectodermal tumor. Three patients were found to be unresectable. All three underwent radiation and chemotherapy. Lobectomies or bilobectomies were per formed in 13 patients including two sleeve resections, one carinal resectio n, and one chest wall resection. Four patients underwent radical pneumonect omies. Three patients with invasion of the pulmonary artery, pulmonary vein s or atrial wall underwent extended resections with the use of cardiopulmon ary bypass. In two, a homograft was used to reconstruct the right ventricul ar outflow tract. Of the resected patients, six had a positive resection ma rgin, and four had at least one positive lymph node in the specimen. Three patients underwent repeat pulmonary resections for recurrences. Eleven pati ents received postoperative chemotherapy and eight had radiation therapy. F ollow-up was available on 22 patients, and ranged from 2 to 183 (mean 48) m onths; 14 patients are disease free, six died of disease, one died of surgi cal complications (operative mortality 5%), and two are alive with disease. Actuarial 3- and 5-year survival of the resected patients was 69%. Size an d grade were not found to be correlated with significantly increased surviv al, but completeness of resection was (P < 0.05). Conclusions: Resection of primary pulmonary sarcomas can produce an acceptable survival rate if the resection is complete. Cardiopulmonary bypass fan be a useful adjunct when tumors involve a resectable area of the heart or great vessels. (C) 1999 El sevier Science B.V. All rights reserved.